Quantitative Electroencephalogram For Early Prediction And Prognosis Evaluation Of Cerebral Hemorrhage After Thrombolysis In Ischemic Stroke

ObjectiveTo explore the clinical value of quantitative electroencephalogram(qEEG)in early prediction and prognosis evaluation of cerebral hemorrhage after thrombolysis in patients with ischemic stroke(IS)Methods21 patients with IS who admitted to ICU of the First Affiliated Hospital of Soochow University from February 2018 to February 2019 and treated with thrombolytic therapy were selected.Patients included in the study received continuous qEEG monitoring after admission to ICU.According to whether there was post-thrombus cerebral hemorrhage,the patients with cerebral hemorrhage were divided into bleeding group(n=6)and non-hemorrhage group(n=15).In addition,3 patients with cerebral hemorrhage after thrombolytic therapy without electroencephalogram monitoring were selected as control group(n=3).Patients included in the study received ECG monitoring,GCS score and NHISS score,state of consciousness assessment and routine treatment.Diagnostic criteria of cerebral hemorrhage after thrombolysis:cerebral hemorrhage visible on CT was reexamined within 24 hours after thrombolysis.If secondary cerebral hemorrhage is suspected during treatment,CT examination was performed at any time.All patients signed an informed consent form.Clinical data collection Baseline data after admission:age,gender,site of infarction,Glasgow score(GCS),national institute of health stroke scale(NIHSS)score,and 28-day survival rate,ICU hospitalization time,total hospitalization time,7-day NIHSS score and 90-day modified Rankin score(mRS)were recorded.qEEG data collection Data was analyzed once every 1 hour.EEG data with stable baseline and no artifacts for no less than 5 minutes were selected for analysis.The data was analyzed by Persyst analysis system and the qEEG indexes ADR(?/? ratio)and ABDTR(?+?/?+? ratio)were derived in Excel form.Collectat the ADR?ABDTR at the time of admission(to)and CT re-examination(ti)of the patients in the non-bleeding group,and the ADR?ABDTR at the time of admission(to)and diagnosis of cerebral hemorrhage(t2)of the patients in the bleeding group.The change rates of ADR and ABDTR of the two groups of patients were calculated.Statistical methodAll data were analyzed by SPSS21.0,and the quantitative data were expressed by mean standard deviation(x±s).T and X2 test was used,and the difference was statistically significant at P<0.05.The correlation between qEEG parameters ADR,ABDTR and GCS,NIHSS and mRS scores was analyzed by Spearman correlation factors.ADR and ABDTR values for predicting cerebral hemorrhage after thrombolysis were analyzed by ROC.Results1.Comparing the baseline data of the bleeding group and non-bleeding group,the age of the hemorrhage group was higher than that of the non-bleeding group,with statistical difference(P<0.05),while the remaining indexes had no statistical difference;The 28-day survival rate,ICU hospitalization time and total hospitalization time of hemorrhage group were relatively higher than those of non-hemorrhage group,but there was no statistical difference(P>0.05).2.Comparing ABDTR and ADR of the bleeding group and non-bleeding group at to,there was no significant difference in each lead between the two groups(p>0.05).3.Comparing the change rate of ADR in the bleeding group and non-bleeding group,the hemorrhage group showed negative growth,with significant differences in leads T3,F3,F7,P3,C3 in the left brain regions(P<0.05),and significant differences in leads T6,F4,O2,FP2,P4,C4 in the right brain regions(p<0.05).4.Comparing the change rate of ABDTR in bleeding group and non-bleeding group,ABDTR in the hemorrhage group was decreased while that in the non-hemorrhage group was increased,with significant differences in leads T3,T5,F3,F7 and P3 in the left brain region(P<0.05),and significant differences in leads T6,F4,FP2,P4 and C4 in the right brain region(p<0.05).5.ROC analysis showed that ADR and ABDTR changes had good predictive value for cerebral hemorrhage after thrombolysis(AUC=0.792 VS AUC=0.719),and there was no statistical significance between the two groups(p>0.05).The best threshold of ADR change rate was-25%(sensitivity 91.7%,specificity 66.7%);The best threshold value of ABDTR change rate was-37%(sensitivity 86.7%,specificity 62.5%).The average change time of ADR,ABDTR was 6.31±2.74h and 7.53±2.56h,there was no significant difference between the two groups(P>0.05),compared with the clinical change time(15.34±2.67h),of the control group was statistically significant(P<0.05).6.Compared with the non-hemorrhage group,the NHISS score after 7 days of onset and the mRS score of the 90-day follow-up in the hemorrhage group were higher,with statistical differences(p<0.05).7.Correlation analysis showed that ADR and ABDTR indexes of the two groups were negatively correlated with NIHSS score and mRS score,and positively correlated with GCS score,with statistical significance(P<0.05).Conclusion1.qEEG as an effective detection tool,and its index ADR,ABDTR can be used to evaluate the high risk of cerebral hemorrhage after thrombolysis of IS;2.ADR,ABDTR had good correlation with NIHSS score and mRS score,which could be used to evaluate patients' short-term neurological dysfunction and long-term prognosis.3.In patients with IS complicated with cerebral hemorrhage after thrombolysis,the symptoms of residual neurological deficits became worse and the long-term prognosis became worse.